| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,071 |
3,241 |
$83K |
| D1120 |
Prophylaxis - child |
2,273 |
1,911 |
$82K |
| D0274 |
Bitewings - four radiographic images |
1,776 |
1,485 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,747 |
1,598 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,672 |
1,382 |
$37K |
| D1110 |
Prophylaxis - adult |
1,660 |
1,267 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,694 |
2,088 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
18 |
$2K |
| D0330 |
Panoramic radiographic image |
78 |
50 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
76 |
49 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
12 |
$1K |